A cut less cruel

An attempt to restore sexual sensation to women whose genitals have been cut

A QUARTER of a century after the start of campaigns to stop communities from maiming their young women, the practice still goes on. Female genital mutilation, to give it its proper name, ranges from a straightforward nick to the complete excision of the clitoris and labia with the remaining genitals sewn up, leaving only a small opening. It is done for cultural reasons in many African countries but also in Asia and the Middle East. The World Health Organisation estimates that some 3m girls are subjected to the procedure each year and that, in total, between 100m and 140m women have undergone it. But now surgeons are working to repair some of the damage.

Surgery to reopen the vagina and mitigate the medical complications of genital cutting has long been available. But in Burkina Faso, where as many as 75% of women are thought to have had their clitorises cut, a relatively new procedure is being offered. Clitoris-reconstruction surgery aims to restore sexual sensation to women who have been mutilated. A year after it was introduced, more than 100 women have elected to have it performed, according to Michel Akotionga of the Yalgado Ouedraogo University Hospital in Ouagadougou. Unlike surgery to reopen the vagina, which is free in Burkina Faso, clitoris reconstruction costs about $150 in a public hospital and up to $400 in a private clinic.

The technique is possible because most of the clitoris resides inside the female body. In cases where the entire external part has been severed, some 2cm is removed but a further 8-10cm remains embedded internally. Surgeons pull it out and stitch it to the skin. Nerve endings in the new protrusion help to create the secretion and engorgement in the genitals that prepare a woman for sex. Unfortunately the technique used by the Burkinabe doctors does not restore sexual sensation completely, because the pressure-sensitive tip of the clitoris is lost.

Pierre Foldes, who started pioneering the reconstruction method some 25 years ago, has now trained 15 surgeons to use the technique in France. Although he supports efforts to restore sexual sensation, he worries that improperly trained surgeons may cause more damage in attempting to repair mutilated women.

Other health workers fear that families unsure of whether to subject their young women to genital mutilation might go ahead on the grounds that a wrong decision can always be corrected later. While a partial cure is better than nothing, prevention would be best of all.